Is the mouth the root of all evil?
Bringing awareness to the above question has been an eye opener for me as much as anyone that is willing to read and listen to me.
We have been aware of the implications of gum disease on systemic health. Diving into the nitty gritty of it all, it makes me so much more conscience to bring this knowledge to Floss Bosses, Floss Bosses’ social media and “teeth cleaning” visits.
In the series of blog posts “Is the mouth the root of all evil?” (Again, thank you Margaret!), I’d like to introduce you to gum disease and pregnancy.
Gum disease is an infection leading to inflammation and destruction of tissue around the tooth. Bleeding, sore, red, enlarged gums are one of the early symptoms associated with gum disease. Gum disease may be triggered by microbes residing in the mouth (example P.gingivalis). The inflammation and destruction may cause the tissue to become more permeable allowing the germs and their by-product to enter the body and increasing body’s inflammation burden.
What’s got this to do with pregnancy?
Pregnancy is a unique state of the body women go through. It is a state where immunological changes occur allowing women to take the pregnancy through the full term. In a nut shell, the embryo is a “foreign” body. Half of the genetic material of the baby doesn’t belong to the mother. Anything that is foreign in genetic material, body will reject it (hence, anti-rejection medication in transplant patients). Mother Nature devised a system where part of mother’s immune system “shuts down” while another works overtime to allow the pregnancy to progress. In addition, female sex hormones promote gum disease pathogens to thrive. All of the above make a pregnant woman more susceptible to infections (1,3).
While women are susceptible to infections when pregnant, pre-existing conditions like gum disease, flourish during pregnancy. Gum disease associated with pregnancy is called pregnancy gingivitis.
Why should we care?
It’s been shown that gum disease may cause pre-term babies and low weight babies. Low-birth-weight and pre-term babies are at risk of:
- neonatal death,
- long-term neurodevelopmental issues (neuromotor, cerebral palsy)
- health problems (asthma, upper and lower respiratory and ear infections)
- congenital anomalies
- behavioural problems (ADHD).
What might be happening? Yet again, the mouth bacteria travel from mom’s mouth to “fetoplacental unit” (2)
The culprit in all this is P.gingivalis (PG) and its ilk. PG is an oral pathogen that hates oxygen, has an armour capsule, increases inflammation, decreases anti-inflammatory factors (the ones that fight inflammation) and causes other microbes to become more aggressive (including Covid-19). Not only that PG up regulates inflammation, it stops the process that helps with down regulating this response.
PG inflammation burden on the body has been shown to enter mother’s circulation and utero-placental tissue potentially impairing placenta development.
Did you know? Some researchers have found that the composition of placental bacteria resemble that of plaque on the teeth (3).
Inflammation process can be destructive if not regulated. It is this process that damages the tissue around the tooth and not the actual germs munching on them (similar to arthritis).
Pregnant women with gum disease are 7X more at risk of delivering premature and low weight baby (2), we must be vigilante at preventing, early detection and diagnosis of gum disease. PG may disturb first trimester remodelling process of the uterus and placenta to prepare it for the embryo… timing of treatment is everything (3). The sooner the better. Better yet…PREVENTION.
What do we do about it at Floss Bosses?
- Prevention. We never ignore bleeding gums in anyone. Regular teeth cleaning prevents and fights inflammation.
- Laser Bacteria Reduction (LBR) to fight microbes affecting the body before every teeth cleaning treatment.
- When a patient is planning to get pregnant while having gum disease, we modify the treatment to address the issue ASAP eg. Laser Assisted Periodontal Therapy (LAPT).
- Prevention (oh yes. We have mentioned it already but will mention it again)
Poor oral health and pre-existing gum disease are major factors in having a premature and or low-weight baby. Although, there might be a genetic predisposition to tolerate infections and inflammation, pre-pregnancy health is very important. Stress level, diet and oral health may all contribute to increase in response and adverse pregnancy outcomes.
Considering that pregnant women are more likely to accumulate plaque, have inflamed and bleeding gums and experience increase in tooth mobility (5), regular teeth cleanings and check ups are imperative to overall health of mom-to-be, pregnant ladies and babies. Please, when you notice bleeding gums, go see your dental hygienist to have it checked and treated.
To all my non-dentals, go floss, brush, get your teeth cleaned & smile for your and your baby’s better health!